The C-SSRS is used extensively across primary care, clinical practice, surveillance, research, and institutional settings. It is available in over 100 country-specific languages, and is part of a national and international public health initiative involving the assessment of suicidality, including general medical and psychiatric emergency departments, hospital systems, managed care organizations, behavioral health organizations, medical homes, community mental health agencies, primary care, clergy, hospices, schools, college campuses, US Army, National Guard, VAs, Navy and Air Force settings, frontline responders (police, fire department, EMTs), substance abuse treatment centers, prisons, jails, juvenile justice systems, and judges to reduce unnecessary hospitalizations. Of note, the CDC adopted the Columbia definitions (referenced in CDC document) and there is a link to the C-SSRS in the new CDC surveillance document. The C-SSRS is frequently asked for or recommended by various international agencies such as the FDA, WHO, JCAHO Best Practices Library, AMA Best Practices Adolescent Suicide, Health Canada, Korean Association for Suicide Prevention, Japanese National Institute of Mental Health and Neurology, and the Israeli Defense Force. The C-SSRS has been administered several million times and has exhibited excellent feasibility – no mental health training is required to administer it.
Of note, one of the main priorities of the Action Alliance, a public-private partnership developed to advance the national strategy for suicide prevention, is the prediction of suicidal behavior, as to foster targeted interventions. The C-SSRS, initially designed for an NIMH-funded suicide study, addresses this goal by showing successful suicide attempt prediction not only in suicidal adolescents, but in non-suicidal adults as well. In the past, typical screening has only identified suicide attempts, omitting some of the most important behaviors that are critical for risk assessment and suicide prevention (e.g. collecting pills, buying a gun). The C-SSRS is the only screening tool that assesses the full range of evidence-based ideation and behavior items, with criteria for next steps (e.g. referral to mental health professionals); thus, the C-SSRS can be exceptionally useful in initial screenings.
“Having a proven method to assess suicide risk is a huge step forward in our efforts to save lives,” said New York State Office of Mental Health Commissioner Michael Hogan. “Dr. Posner and her colleagues have established the validity of The Columbia–Suicide Severity Rating Scale (C-SSRS). This is a critical step in putting this tool in the hands of health care providers and others in a position to take steps for safety. We congratulate them on their efforts."
Jeffrey Lieberman, M.D., chairman of Columbia’s Department of Psychiatry and director of the New York State Psychiatric Institute said: “For the first time in as long as anyone can remember, we may be actually able to make a dent in the rates of suicide that have existed in our population and have remained constant over time. And that would be an enormous achievement in terms of public health care and preventing loss of life.”
The C-SSRS has been associated with decreased burden by reducing unnecessary interventions and redirecting limited resources; In the Rhode Island Senate Commission hearing, state senators discussed using the C-SSRS to address ER overuse and ER diversion, to be used by EMS or police in the community.
Hospital system: steadily decreased one-to-ones (27,000 screened)
- Reading Hospital - “allowed us to identify those at risk and better direct limited resources in terms of psychiatric consultation services and patient monitoring and it has also given us the unexpected benefit of identification of mental illness in the general hospital population which allows us to better serve our patients and our community.”
- New York City middle schools/nurses: Identified children that would have otherwise been missed while dramatically reducing unnecessary referrals. One district ~60-90% of the referrals are unnecessary
- NYC problem: The great majority of children & teens referred by schools for psych ER evaluation are not hospitalized & do not require the level of containment, cost & care entailed in ER evaluation.
- Evaluation in hospital-based psych ER’s is costly, traumatic to children & families, and may be less effective in routing children & families into ongoing care
- California corrections department spent $20 million on suicide-watch in 2010, which they believe could be cut in half by these methods
According to a mental health attorney specializing in malpractice litigation, Bruce Hillowe, the C-SSRS has the potential to aid practitioners in taking necessary liability precautions, stating, “If a practitioner asked the questions...It would provide some legal protection.”